What I found at a maternity centre in Mbale, Uganda — and what it is teaching me about birth

I have been at Shifrah and Puah Maternity Center in Mbale, Uganda for a month now, and I leave next week.

I had come with a question that has been forming in me since I started this work, a question about whether matrescence, the profound transformation of becoming a mother, is truly universal. Whether the psychological and identity-level dimensions of that passage move through every woman regardless of where she lives, how she births, or what cultural container holds her through it. I had come to Uganda to live closer to that question. To witness birth in a context I had never witnessed it in before, and to see what it might reveal.

The centre

Shifrah and Puah Maternity Center sits at the top level of a clinic in Mbale, in eastern Uganda. Three birthing rooms. Basic in the best sense of that word, everything that is needed to support a woman through a physiological birth experience, and nothing that is not. It is clean. It is calm. It is a space where birth is understood as something the body already knows how to do.

There are four midwives who work there, rotating across day and night shifts, splitting the week between them. On any given shift there is one midwife on duty. Sometimes she is supporting one woman. Sometimes, when the flux arrives as it does in any maternity centre, she is holding four or five women simultaneously. The work is demanding in a way that most Western birth workers would find confronting. The resource constraints are real. And yet what I have witnessed in this space consistently is a quality of calm, of presence and of clinical competence that I want to carry back with me.

One midwife in particular has changed something in how I understand this work. Her approach is gentle and deeply caring. She moves through the birth space without urgency, without performance, without the kind of clinical efficiency that can drain the humanity from a room. She is simply present. Completely, unhurriedly present. And the women she attends feel that.

How they practice

The centre follows protocols led by the main hospital in Mbale, which means there are constraints on how independently the midwives can practice. But within those constraints, what they offer is genuinely physiological.

They do not rupture membranes artificially. They do not use forceps or vacuum. They do not perform episiotomies. They do not impose a time limit on labour as long as the baby is safe. Sutures, when needed, are performed by the midwives themselves. The women birth on their backs, which is the tradition here and the position they know. Pitocin is administered routinely after birth, not as an intervention in the Western sense but as a practical response to reality. Most of the women who come to Shifrah and Puah live in villages and do not have access to emergency obstetric care if something goes wrong. The risk of postpartum haemorrhage and its consequences in this context is not abstract. It is the reason for many of the protocols that might look different through a Western lens.

Every day the centre holds antenatal visits where mothers and babies are seen, monitored and supported through their pregnancy. Iron supplementation and anti-malarial treatment are provided as standard, both essential in a context where anaemia and malaria in pregnancy carry serious consequences for mother and baby. These daily visits are a quiet but significant part of what the centre offers, keeping women connected to care throughout their pregnancies in a community where access to health services is not guaranteed.

Everything at the centre is free except ultrasound, which costs approximately twelve Australian dollars, an amount that is genuinely out of reach for many of the families who come here. Antibiotic treatment, when needed, must be paid for separately. The centre tests every mother for HIV, syphilis, hepatitis B, malaria and urinary tract infection. Babies receive vitamin K and eye ointment. Vaccinations are offered for mothers and babies against malaria, polio and tetanus.

Paper records. No computers. A clinical environment that is a world away from the digitised, monitored, documented experience of birth in an Australian hospital and yet one that functions, day after day, with competence and care.

What surprised me

I did not expect to find breastfeeding so universal and so immediate. Every woman here breastfeeds. Not as a choice made after reading the evidence but as an economic and biological necessity, formula is simply not accessible for most families. What this means in practice is that the first feed happens naturally, without the negotiation and encouragement and often anxiety that surrounds it in the postnatal wards I am familiar with. The baby goes to the breast. The mother knows it. The midwife supports it without ceremony.

What moved me most: The postpartum

In Uganda, the postpartum period is not a private, domestic affair. It is a communal one. When a woman gives birth at Shifrah and Puah, she is rarely alone. Family members come. Neighbours come. The religious community comes. The baby is held and passed and cared for by many hands, which means the mother can rest in a way that most Australian women in the postpartum period simply do not.

This is not a romantic observation. It is a clinical one. The research on postnatal depletion, on maternal isolation, on the epidemic of postpartum mental health difficulties in Western countries, points directly to this absence. The village that holds the mother is not a metaphor here. It is a literal, functioning reality. And watching it operate has changed something in how I understand what women in Australia are missing and what we need to build back.

This is matrescence being held collectively. Not named. Not theorised. Simply lived.

That is what I came here to find. And it is here, in every room, in every birth, in every woman who walks out of this centre held by the people who came with her.

The honest picture

I want to be honest about something, because this post would not be complete without it.

Shifrah and Puah is not a perfect birth environment. No birth environment is. But the imperfections here are not the same imperfections I encounter in Australian hospitals. They are different, shaped by a different culture, a different history, a different set of constraints and a different understanding of what birth is for and who it belongs to.

There are things I have witnessed here that have sat uncomfortably with what I know and what I believe about birth. I am not going to name them yet because they will come through in the birth stories I will share in the weeks ahead. What I want to say now is simply this, that I have tried to hold what I have witnessed with curiosity rather than judgment, and that has not always been easy.

The question I keep returning to is whether what I am observing is a cultural difference that deserves respect and curiosity, or a practice that causes harm regardless of its cultural context. Those are not always the same question and they do not always have the same answer. Sitting with that distinction honestly, without rushing to resolve it, has been one of the most demanding parts of this experience.

What I can say with certainty is that the midwives at Shifrah and Puah are doing this work with genuine care, within the constraints of their training, their resources and their context. My role here is not to bring Western birth knowledge and transplant it. It is to be present, to learn, to contribute where I am invited to and to carry home a more complete picture of what birth looks like when it is held differently.

That picture is richer for its complexity. All honest pictures are.

A note on what comes next

In the weeks ahead I will be sharing individual birth stories from my time at Shifrah and Puah. Each one is anonymised. Each one carries something I want to bring back into my practice and into my understanding of what it means for a woman to cross the threshold into motherhood.

They are not perfect stories. Birth never is. But they are real ones. And that is what matters.

If this resonates with you and you feel called to support the work Shifrah and Puah Maternity Center is doing, you can learn more about them and donate directly through their website at shifrahandpuahmaternitycenter.org. Every contribution goes directly toward the care of women and babies in Mbale who have almost no other access to safe, supported birth.

— Sabah, The Line Between · Beaufort, VIC

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Sabah is a certified doula and acupressure therapist based in Beaufort, Victoria. Her practice, The Line Between, is rooted in the philosophy of matrescence, the profound transformation of becoming a mother that deserves to be held with knowledge, presence and deep respect. She came to this work through her own pre-conception journey and a deep conviction that matrescence is a universal feminine passage that every woman deserves to move through with community, language and care. She is also the founder of The Mother's Village, a monthly gathering circle for women on every part of the motherhood journey. She writes from the threshold as a practitioner, a thinker and a woman navigating this passage herself.

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